Welcome to the Department of Health Care Services Welcome to Medi-Cal Welcome to the Department of Health Care Services

Medi-Cal Logo

Family PACT Claim Example ICD-10 Updates

October 16, 2015

References to the International Classification of Diseases, 10th Revision Clinical Modification (ICD-10-CM) diagnosis codes are not listed in the Claim Completion: CMS-1500 and the Claim Completion: UB-04 sections of the Family PACT Policies, Procedures, and Billing Instructions manual. The updates to these sections will be included in a future Family PACT Update.

Updates to these Family PACT manual sections include:

  • Claim form billing examples with an ICD-10-CM diagnosis code use an ICD indicator of “0” in the appropriate field
  • Claim form billing examples use generic ICD-10-CM place holder codes. For example:
    • D1D1D1D for primary ICD-10-CM codes, D2D2D2D for Secondary ICD-10-CM codes etc.

Providers should refer to the Benefits: Family Planning and Benefits: Family Planning-Related Services sections of the Family PACT manual for the appropriate ICD-10-CM codes.

For general ICD-10 information, click on the ICD-10 FAQs.